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Updated: Apr 12, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Midupper Arm Circumference Outperforms Weight-Based Measures of Nutritional Status in Children with Diarrhea
Payal Modi1, Sabiha Nasrin2, Meagan Hawes3
1The Warren Alpert Medical School, Brown University, Providence, RI;
Insights
Mid-upper arm circumference (MUAC) and MUAC z scores (MUACZ) accurately identify undernutrition in children with diarrhea. Weight-based measures like WAZ and WLZ are unreliable due to dehydration, leading to misdiagnosis.
Area of Science:
- Pediatric Nutrition
- Global Health
- Diagnostic Accuracy
Background:
- Undernutrition causes 45% of global deaths in children under 5.
- Diarrhea is a major contributor to childhood undernutrition and mortality.
- Validated tools for assessing undernutrition in children with diarrhea and dehydration are lacking.
Purpose of the Study:
- To assess the validity of different anthropometric measures for identifying undernutrition in children experiencing diarrhea.
- To compare the accuracy of weight-for-age z score (WAZ), weight-for-length z score (WLZ), mid-upper arm circumference (MUAC), and MUAC z score (MUACZ) in this population.
Main Methods:
- A prospective cohort study involving 721 children under 60 months with acute diarrhea in Bangladesh.
- Anthropometric measurements (WAZ, WLZ, MUAC, MUACZ) were taken pre- and posthydration.
- Measurements were evaluated for their ability to correctly identify undernutrition across varying dehydration levels.
Main Results:
- MUAC and MUACZ showed 92-94% agreement pre- and posthydration, unaffected by dehydration.
- WAZ and WLZ had lower agreement (69-76%) and were significantly affected by hydration status.
- Weight-based measures misclassified 12-14% of children with severe underweight or SAM, versus 1-2% for MUAC/MUACZ.
Conclusions:
- MUAC and MUACZ are the most accurate and reliable indicators of undernutrition in children with diarrhea.
- Dehydration significantly impacts WAZ and WLZ, leading to potential misdiagnosis of severe underweight and SAM.
- This study highlights the superiority of MUAC-based measurements in pediatric diarrheal illness.
Background:
Undernutrition contributes to 45% of all deaths in children <5 y of age worldwide, with a large proportion of those deaths caused by diarrhea. However, no validated tools exist for assessing undernutrition in children with diarrhea and possible dehydration.
Objective:
This study assessed the validity of different measures of undernutrition in children with diarrhea.
Methods:
A prospective cohort study was conducted at an urban hospital in Bangladesh. Children <60 mo of age presenting to the hospital rehydration unit with acute diarrhea were eligible for enrollment. Study staff randomly selected 1196 children for screening, of which 1025 were eligible, 850 were enrolled, and 721 had complete data for analysis. Anthropometric measurements, including weight-for-age z score (WAZ), weight-for-length z score (WLZ), midupper arm circumference (MUAC), and midupper arm circumference z score (MUACZ), were calculated pre- and posthydration in all patients. Measurements were evaluated for their ability to correctly identify undernutrition in children with varying degrees of dehydration.
Results:
Of the 721 patients with full data for analysis, the median percent dehydration was 4%. Of the 4 measures evaluated, MUAC and MUACZ demonstrated 92-94% agreement pre- and posthydration compared with 69-76% for WAZ and WLZ. Although each 1% change in hydration status was found to change weight-for-age by 0.0895 z scores and weight-for-length by 0.1304 z scores, MUAC and MUACZ were not significantly affected by dehydration status. Weight-based measures misclassified 12% of children with severe underweight and 14% with severe acute malnutrition (SAM) compared with only 1-2% for MUAC and MUACZ.
Conclusions:
MUAC and MUACZ were the most accurate predictors of undernutrition in children with diarrhea. WAZ and WLZ were significantly affected by dehydration status, leading to the misdiagnosis of many patients on arrival with severe underweight and SAM. This trial was registered at clinicaltrials.gov as NCT02007733.
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